Acute appendicitis: prospective evaluation of a diagnostic algorithm integrating ultrasound and low-dose CT to reduce the need of standard CT

Poletti, Pierre–Alexandre; Platon, Alexandra; Perrot, Thomas de; Sarasin, François; Andereggen, E; Rutschmann, Olivier Thierry; Dupuis-Lozeron, Elise; Perneger, Thomas; Gervaz, Pascal; Becker, Christoph

doi:10.1007/s00330-011-2212-5

Cited by 51 publications

(33 citation statements)

References 38 publications

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“…Several published studies have compared the diagnostic accuracy of sonography and CT and have proposed sonography as a primary diagnostic tool, followed by CT only in select cases. 17,18 Although those studies differed somewhat from our study in that they did not perform CT when a definite diagnosis was obtained with sonography, our study also supports a similar conclusion. In another study that prospectively compared the accuracy of sonography versus CT for detecting appendicitis in patients with acute abdominal pain, CT showed higher sensitivity compared to sonography, but there was no significant difference in the predictive values of CT and sonography.…”

Section: Diagnosis On Both Sonography and Ct Final Diagnosissupporting

confidence: 78%

Does Computed Tomography Have Any Additional Value After Sonography in Patients With Suspected Acute Appendicitis?

Koo

Kim

Yang

et al. 2013

J of Ultrasound Medicine

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cute appendicitis is the most common condition requiring prompt abdominal surgery to minimize morbidity and mortality. Sonography and computed tomography (CT) have been widely used as the preferred imaging tools in patients with suspected acute appendicitis. 1 In previous studies of these diagnostic techniques, the sensitivities and specificities of sonography were 67% to 88% and 78% to 100%, respectively, whereas the sensitivities and specificities of CT were 76% to 96% and 75% to 95%. [2][3][4][5][6] Hye Soo Koo, MD, Hyun Cheol Kim, MD, Dal Mo Yang, MD, Sang Won Kim, MD, Seong Jin Park, MD, Jung Kyu Ryu, MD Received December 17, 2012, Objectives-The purpose of this study was to evaluate the additional value of supplementary computed tomography (CT) after sonography for diagnosing acute appendicitis.Methods-Among 140 consecutive patients with suspected acute appendicitis who underwent both initial sonography and supplementary CT within 12 hours, 88 patients whose appendices could not be visualized on sonography were excluded. The remaining 52 patients (mean age, 37.3 years; range, 15-98 years) were enrolled in this study. Two radiologists retrospectively reviewed the findings of 52 sonographic and CT examinations, and the appendix of each patient was classified as normal, equivocal appendicitis, nonperforated acute appendicitis, or perforated appendicitis. Causes of right lower quadrant pain other than appendicitis were also recorded. The additional value of supplementary CT was evaluated by performing head-to-head comparisons between CT and sonographic results.Results-No patients with a normal appendix on sonography showed appendicitis on CT. In addition, there were no patients with a sonographic diagnosis of appendicitis who had a normal appendix on CT. Ten patients (19.2%) were determined to have additional value gained from CT. Among these 10 patients, however, the additional information from CT affected treatment modality decisions in only 5.Conclusions-Initial sonography can be as effective as CT in patients with suspected acute appendicitis when the results are definite. Supplementary CT should only be performed when sonography is inconclusive.

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Section: Diagnosis On Both Sonography and Ct Final Diagnosissupporting

confidence: 78%

Does Computed Tomography Have Any Additional Value After Sonography in Patients With Suspected Acute Appendicitis?

Koo

Kim

Yang

et al. 2013

J of Ultrasound Medicine

View full text Add to dashboard Cite

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“…The sensitivity and specificity of CT for the diagnosis of acute appendicitis have been reported to range from 70 to 100% and from 91 to 100%, respectively [3][4][5]. The main CT findings of acute appendicitis are appendiceal enlargement (diameter >6 mm), a thickened wall (maximum wall thickness >2 mm) with enhancement, or periappendiceal fatty stranding [2,6].…”

Section: Introductionmentioning

confidence: 98%

Reassessment of CT images to improve diagnostic accuracy in patients with suspected acute appendicitis and an equivocal preoperative CT interpretation

et al. 2011

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• Numerous patients with clinically equivocal appendicitis do not have acute appendicitis • Computed tomography (CT) helps to reduce the negative appendectomy rate • CT is not always infallible and may also demonstrate indeterminate findings • However knowledge of significant CT variables can further reduce negative appendectomy rate • An equivocal CT interpretation of appendicitis should be reassessed with this knowledge.

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“…If ultrasound is positive and agrees with clinical findings, there is no need to perform additional imaging studies. [25][26][27] …”

Section: Resultsmentioning

confidence: 99%

The use of ultrasonographic and Alvarado scores in evaluating abdominal pain suggestive of acute appendicitis

et al. 2017

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Background: Ultrasonographic scores for appendicitis to determine if, combined with Alvarado scores, they can increase the sensitivity and specificity of the diagnosis of appendicitis.Methods: All cases of abdominal pain suggestive of appendicitis presented between 2013 and 2015 were analysed. An Alvarado score was obtained. All patients underwent ultrasound, and an ultrasonographic score was determined, including the appendicitis classical findings.Results: Two hundred and fifty-one patients with abdominal pain in the right lower quadrant were analysed. Appendicitis was confirmed in 211 (84%) patients. For these patients, the average Alvarado score was 7.95/10 (±1.25) vs. 5.7/10 (± 1.11) for patients who did not have appendicitis (p < 0.001). In patients with confirmed appendicitis, the average ultrasonographic score was 2.48/6 (± 1.06) vs. 0.6/6 (± 0.92) for patients who did not have acute appendicitis (p < 0.001). The ultrasonographic score has a sensitivity of 90% and a specificity of 87% with only two parameters. The combination of the Alvarado and ultrasonographic scores decreased the percentage of negative appendectomies to 2.36% and increased the area under the curve by 0.970.Conclusions: The sum of the Alvarado and ultrasonographic scores provides an efficient alternative for diagnosing abdominal pain suggestive of appendicitis and predicts which patients should undergo surgery with good certainty.

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Acute appendicitis: prospective evaluation of a diagnostic algorithm integrating ultrasound and low-dose CT to reduce the need of standard CT

Cited by 51 publications

References 38 publications

Does Computed Tomography Have Any Additional Value After Sonography in Patients With Suspected Acute Appendicitis?

Does Computed Tomography Have Any Additional Value After Sonography in Patients With Suspected Acute Appendicitis?

Reassessment of CT images to improve diagnostic accuracy in patients with suspected acute appendicitis and an equivocal preoperative CT interpretation

The use of ultrasonographic and Alvarado scores in evaluating abdominal pain suggestive of acute appendicitis

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